Surgical instrument



Jan. 16, 1934. w. J. MCFADDEN SURGICAL INSTRUMENT Filed June 21, 1952FIG. I

INVENTOR. W/ZZ/A/V JI/c/WflDf/Y 'A'T ORNEYI Patented Jan. 16, 1934PATENT "OFFICE SURGICAL INSTRUMENT William J. McFadden, Cedar- Rapids,Iowa Application June 21, 1932. Serial No. 618,457 12 Claims. (01.174-89) My invention relates to surgical instruments and has particularrelation to electrodes suitable for use in diathermy and kindred medicaland surgical treatments.

The tonsils have long been recognized as a com mon site of focalinfection bearing a causal relationship to arthritis, neuritis, certainforms of heart trouble; etc. But within the last few years, attentionhas been called to certain infectious diseases of the cervical canal,processes which are situated in the small glanda'and in the largerglands around the cervical opening which have become cystic and whichcontain mucoid or mucopurulent material. Such infections are constantlyfound, especially in cases of rheumatic involvement of small joints inwomen, and in cases of ocular disease, such as chronic recurring iritis,inflammation of the ciliary body, and phlyctenular keratitis, whichappear first in one eye and then in the other, often greatly injuringthe sight.

Treatment of infection in the tonsils or in the cervix may be carried onin any one of several ways, but the present generally accepted therapyis the complete removal of the infected tissue. This can be donesurgically, or by heat destructive methods, such as the cautery, ordiathermy coagulation; My present invention deals with the method oftreating infected tonsils and infected cervix by means .of heatdestruction, in the form of diathermy coagulation, and my inventionprovides an electrode particularly well suited for such treatment. I g

It is apparent that a device constructed according to my invention maybe used or modified for and like disorders which are difiicult to reach.

I have devised an instrument Which, by reason of its construction, iscapable of a much wider field of usefulness than the devices ofthe priorart and in which treatment of definite selected areas is accuratelyobtai ed without effect upon unselected areas. The arts of the deviceare readily interchangeable for treatment of various sized areas and fortreatment of canals of various diameters and configurations. The extentof the area treated may be readily regulated while the instrument is inplace and the instrument may be inserted and removed with the conductorsthereof sheathed in a non-conducting shell.

A broad object of my invention, therefore, is to provide a new andimproved electrode for treating endocervicitis, both acute and chronicand of both specific and non-specific character, to destroy anyinflammation of the Bartholin glands, to destroy erosions of anymagnitude around the external os of the cervix, to promote healing ofbilateral tears of the cervix, to destroy polyps and cysts of anymagnitude adhering to the vaginal portion of the cervix, to treat anddestroy infected tonsils, and to treat and destroy benign and malignanttumors.

A more particular object of my invention is to provide an electrode inwhich the conductors may be sheathed or partly or fully exposed whilethe instrument is being inserted and removed and while it is being used.

Another object of my invention'is to provide a device of the abovecharacter which is adapted to treat selected areas and which may beregulated to treat areas of varying widths and depths without affectingadjacent areas.

Another object of my invention is to provide a device which is adaptedfor the treatment of tonsils or tumors or the like, and which may alsobe used for the treatment of the walls of canals of varying diametersand shapes and which is furthermore adapted for the treatment of onlycertain portions of the walls of such canals as selected by theoperator.

Still another object of my invention is to provide a device of the abovecharacter which is adapted to treat selected areas in equal uniformitythroughout the area treated and such that the strength of treatment canbe so gauged and set that all subsequent treatments can be given inidentical strength and uniformity.

Other and further features and objects of the einvention will be moreapparent to those skilled in the art .upon a consideration of the accomepanying drawing and following specification, wherein are disclosedseveral exemplary embodiments of the invention, with the understanding,however, that such changes may be made therein as fall within thescope.of the appended claims without departing from the spirit of theinvention. The device maybe used or adapted for use for other purposes.

In said drawing:

Figure 1 is a view, partly in elevation and partly in section, of anembodiment of my invention in which the conductors which project fromone end of the device may be regulated in and out with reference to theinsulating sleeve for use in treating certain restricted areas and fortreating various canals in the anatomy.

Figure 4 is a view in side elevation of the electrode shown in Figure 3.v

Figure 5 is a view inside elevation of an electrode constructedaccording to my invention and utilizing a structure which is adapted toselectively cover a portion of the exposed conductors.

Figure 6 is a plan View of an electrode constructed according to myinvention and adapted for use in selecltively treating the walls oflarge canals or cana s of varying diameteror shape, or curved areas inthe anatomy, more particularly in treating large erosions and bilateraltears about the external os of the cervix.

Figure 7 is a view in perspective of an electrode constructed accordingto another embodiment of my invention, and this embodiment findsparticular use in puncturing and treating tonsils, cysts and tumors," orcurved areas in the anatomy.

Figure 8 is a 'view in perspective of another embodiment of my inventionwhich finds particular use in treating the diseased area about the mouthof the cervix, for treating bilateral tears, or mouths of glands orinfected folds or crevices and for surface application on tumors,tonsils, cysts and the like, and

Figure 9 is a diagrammaticview showing how a device constructedaccording to my invention may be used so that stenosis and likeadhesions are prevented.

Referring now more particularly to Figure 1, there is shown, generally,an elongated cylindrical sleeve 10 which is slidingly engaged within aknob or handle 11. A pair of needle-like'conductors 17 pass through theknob, are engaged thereto, and the sleeve 10 is preferablyslidinglymounted over the conductors. The sleeve 10, an inner insulating rod 19,and the handle 11 may be made of any suitable insulating material suchas a phenolic condensation product, hard rubber, or similar insulatingmaterial.

The handle 11 is preferably a bottle-shaped cylinder and is provided atits outer end with a pair of parallel-extending bores 12 which extendfrom the outer end and part way into the" A pair of electricallyconducting sleeves handle. 13 are located within the bores 12 and thesesleeves constitute the female portion of the connector in which the maleplugs 14 of the conductors 16, shown in Fig. 2, may be inserted. Anysuitable conductors and plugs may be utilized and these conductors andplugs constitute no part of my present invention except as a means ofconducting current to the needles 17 of the electrode.

A pair of slots or grooves are cut in the adjacent portions of the innerends of the sleeves 13 and the outer or lower ends of the needle-likeconductors 17, whose diameters are approximately the thickness of thewalls of the sleeves 13, are

soldered or otherwise secured to the sleeves and i in the grooves. Theupper ends of these conductors are preferably sharpened as shown at 18in order that they may be inserted into diseased areas or into suchbodies as cysts, tumors and the like, and also so that they may readilymake contact with the conductors of modified forms of electrodes whichare shovm in the drawing and which are hereinafter more particularlydescribed.

While the sleeve 10 might readily be a solid rod slidably engaged on theconductors 17, it is preferable, from the standpoint of manufacturing efI ficiency, and in order that the parts of the de vice may be readilycleaned, that an inner rou 19 be employed for furnishing support to theconductors 17. This inner rod 19 has preferably a sliding fit within thesleeve 10 and is, of course, drilled with longitudinal bores adapted toreceivi, the conductors 17. The insulating rod 19 covers the needles orconductors -17 from the point where they emerge into the recess in thehandle 11 up to the upper end of the sleeve 10 and is glued or.otherwisesecured to them.

The inner rod 19 is preferably shorter than the outer sleeve in orderthat a cylindrical recess is providedat the inner or upper end of theelec trode as at 2 3. The sleeve 10 preferably taperw at its upper orinner end, as shown at22, in or der that this portion of the electrodewill be 0111;,

slightly greater in outside diameter than the re cess 23 so that arelatively smooth joint may b. made between the sleeve and the partsherein after more particularly described.

The sleeve or stem 10, as has been explained, i slidingly engaged withinthe handle 11, and the relative outside diameter of the stem 10 and theinside diameter of the handle 11 is preferable such that the handle willnot move on the sleeve unless it is moved by the operator.

The extent of movement of the stem 10 within the handle 11 is preferablylimited. Although this result may be accomplished inseveral ways. Iprefer to provide a groove 27 within the outer or lower wall of the stem10 and to suitably drill the handle 11 and insert a plug 28 thereinwhich projects into the groove 27.

The plug 28 may be of a different color iron. the handle and may be soaligned with the instru ment that the operator may determine the exactposition of the projecting ends of the conductor. 17, and of theconductors of the devices herein after described, even when they arehidden from view, as in using the instrument. The dot of con trastingcolor furnished by theplug 28 may alsn be used to indicate to theoperator how far the instrument has rotated or is being rotated in use.130

It is apparent that movement of the stem 10 in the handle 11 will causethe conductors 17 to project to a greater or lesser extent in accordancewith the position of the stem 10 in the handle, and it will be apparentfrom descrip 35 tions more particularly hereinafter made, that thismeans of controlling the conductors 17 with reference to the stem 10 bymeans of a handle located at the outer end of the electrode, isparticularly advantageous.

The importance of the features just describeu becomes more apparent onconsideration of the structure shown in Figure 5. This structure com--prises a removable sheath 20, having a pair of parallel bores 21extending the length thereof, in order that the sheath may be slipped onover the projecting ends of the conductors 17. The lower or outer end ofthe sheath is preferably cylindrical in shape and is of such a diameterthat it has a relatively tight fit within the recess 23'of the thetechnique of this operation, reference may stem 10. It is apparentthat-if the outside diameter of the outer end of the sheath issufiiciently great that the sheathhas a tight fit within the stem 10 andif the bores 21 of the sheath are slightly greater than the diameter ofthe conductors 17, that when the sheath is in place on the end of thestems, the conductors 17 may be moved in and out of the sheath by movingthe handle 11 and the sheath will not be dislodged from the stem 10except when the operator manually removes it.

The sheath is preferably flattened, as shown in Fig. 5, from a pointclose to the sleeve 10 to the upper end so as not to obstruct the lineof vision to the conductor points 18 when the instrument is in use. It;is apparent that the conductors or needles 17 may be completely sheathedwithin the sheath 20 or may be made to project from it to any desiredextent.

' The sheath shown in Figure 5 is preferably used for treating cysts andlike tumors. If the cyst or other tumor is located within a cavity, theusual technique is to cover the ends of the needles by moving the handle11 outwardly on the stem 10,

to insert the end of the electrode in the cavity with the inner end ofthe sheath adjacent the part to be treated, to move the handle on thestem until the points *18 of the conductors 1'7 project to the desiredextent from the end of the sheath, to insert the point into the tumor,to turn on the electric current for a desired period of time, and tothen remove the points, slide the sheathpver the points and remove theinstrument from the cavity.

It is apparent therefore that the instrument may be inserted in a cavityWithout exposing the points of the conductors and that the points maythen be uncovered to the extent desired and in accordance with thedesired depth of treatment. The end of the sheath will prevent thepoints from projecting into the tumor to a greater extent than desired.In this way the walls of the cavity in which the instrument is used arenot injured while the instrument is being inserted and removed.

In Figures 3 and 4 is shown a tip 29 in which a portion of a side as at31 has been cut away so that when the conductorsl'l are inserted in theparallel bores 32 of the tip, the conductors are exposed, but areseparated by a ridge 34 of insulating material. The end of the tip 29 isslightly enlarged as shown at 33 and is preferably oliveshaped tofacilitate inserting and removing the tip innarrow canals and folds. Theend 33 of the tipis preferably brought up over the ends of the channels32 in order to cover the tips and points of the conductor-17.;

The bores29 are perfectly parallel and lie in the same plane.Consequently when the conductors 17 are inserted in the bores, they,too, are

, parallel and lie in the same plane and therefore stricted areas,crevices and the like.

In operation the tip is inserted in the canal or other crevice and thecurrent applied. The electrode tip may be held in one place or may berotated or moved as desired. For an explanation of be had to Fig. 9,which is an enlarged diagrammatic view of a section of the wall of acanal or the like. In treating this area, the tip would be insertedwithin the canal with the conductors in contact with a portion of thewall of the canal as shown at 30 and the current turned on. Theelectricity would flow between the two conductors and producecoagulation of the portion of the wall between the two conductors. Therest of the wall would not be affected because the electrical currentwould take the shortest path. After treatment of one portion of thewall, the current would be turned off, the tip rotated through 180degrees, the current turned on and an oppositely disposed portion of thewall coagulated. The

current would then be turned off and the tip removed. Two months laterthe coagulation operation would be repeated with the instrumentappliedto the two remaining untreated portions of the treated portionsaway from each other untilregrowth of mucous membrane is completed.

- It is apparent that fiat or curved areas may be treated in the sameway and that accurate control of the area of treatment may readily besecured. It may readily be understood that the tip shown may be utilizedon canals of substantially the same diameter as the tip, or of amaterially greater diameter by moving or rolling the tip over the areato be treated.

Another form of tip is shown in Figure 6. In this form of tip, which maybe termed the conical tip, a small cylindrical portion thereof, as at36, is adapted to fit within the end of the stem 19, and another portion37 of! the tip is constructed in a tapered and curved cone shape asshown. The portion 37 is really a modified frustum of a cone in orderthat the blunt inner end thereof may be readily inserted in variouscavities or canals which are to be treated.

A pair of auxiliary conductors 38 extend in substantial parallelrelation through suitable channels 39 within the tip, out over the endof the tip, out and back along the side of the cone-shaped portionthereof and are fastened at the outer ends by inserting them in suitableradially-disposed openings 41 in the wall of the cone tip 37'. Channels32b are formed within the cylindrical portion 36 of the tip and extend alittle more than half-way into the conical portion of the tip. It willbe noticed that the bores 32b and 39 are not concentric but are slightlyoffset so that when the tips 18 of the conductors 17 are inserted in thebores 32b, the ends thereof are wedged into contact with the conductors38 thereby completing electrical connections therewith.

This conical tip is well adapted for treating the walls of relativelylarge cavities and canals or curved areas. If, for instance, a largecanal is to be treated, the cone tip may be made to contact either acertain restricted area or may be rolled or rotated about to contactlarger areas or the entire area of the canal.

Another form of tip is shown in Figure '7 at 43.. This form of tip issubstantially of the same appearance as the sheath shown in Figure 5,but is longer and the flattened portion starts in at a distance of aboutone-third the length between the stem and the end of the tip. A pair ofconductors 44 are molded into the upper or outer end of the tip or, if amoldable composition is not secured in suitable parallel, longitudinalbores 46. The conductors 44 are preferably curved and pointed at theirexposed ends. Other parallel bores 47 extend from the lower or outer endof the tip into the tip and these bores communicate but are notconcentric with the bores 46. The bores 46 and 47 are oil-center withrespect to. one another in order that when the conductors 17 areinserted in the tip 43, and the tip inserted in turn in the recess 23 ofthe stem 10, the conductors 17 will make electrical contact with theconductors 44.

This form of tip is of particular advantage in the coagulation oftonsils, and like bodies. The curved, pointed ends of the conductors 44may be inserted into the tonsil and the current turned on for a selectedperiod of time to coagulate the tonsil as desired. The instrument shownin Figure 1 may be used just as readily with this form of tip as withthe others and therefore constitutes an instrument which may be used forthe coagulation of tonsils as well as coagulation of other portions ofthe anatomy.

Still another form of tip is shown in Figure 8 at 51. This tip 51 is of,substantially the same shape and appearance as the tip 43 except thatthe conductors 52, instead of being curved and sharpened as shown inFigure '7, are bent at an angle of about 30 degrees with reference tothe plane of the flattened portion of the sheath and are blunt at theends thereof. The conductors 52 are embedded or secured within the endof the tip in the same manner as the conductors 44, and parallel bores47 within the tip permit the conductors 17 of the stem 10 to be insertedtherein, to make electrical contact with the conductors 52.

This tip may be used for the treatment of the v outer walls of bulbousbodies such as the external walls of the cervix. In treating bodies ofthis type the parallel ends of the conductors 52 are placed against aportion of the outer wall of the body to be treated, the current turnedon, and the instrument rotated to cause the conductors to successivelycontact areas on the outer wall as desired.

It is apparent that with my invention it is possible to treat almost anytype or size of affected areas whether they be in a plane, curved, orthe walls of canals and other cavities. Devices constructed according tomy invention may be used to treat'tonsils, tumors, cysts and the like.Still other embodiments of my invention may be used for treating bulbousbodies of various kinds. It is apparent that the device may be readilyad- Justed while it is beingused or during insertion and removal of theinstrument so that the conductors may be fully or partly exposed or maybe entirely concealed. It will be readily understood that the devicewill find many new uses and may be modified as desired.

Such modifications as may be made by those skilled in the art may bemade without departing from the spirit and scope of my invention as setI forth in the appended claims.

'1 having a groove located beneath the handle and the handle having aprojection extending into the groove whereby the motion of the stemwithin the handle may be limited.

2. In a surgical instrument for electrical treatment comprising a stemportion and electrodes located within the stem and extending therefrom,a tip of insulating material adapted to be fastened to the stem andprovided with channels for the reception of the conductors, and the tipbeing cut away so as to expose the channels and the conductors through aselected intermediate portion of their length.

3. In a surgical instrument for electrical treatment comprising a stemportion and electrodes located within the stem and extending therefrom,a tip of insulating material adapted to be fastened to the stem andprovided with channels for the reception of the conductors-the tip beingcut away so as to expose the channels and the conductors through aselective portion of their length, and the end of the tip being broughtup in a knob adapted to cover the ends of the conductors when they arein place in the channels.

4. In a surgical instrument a stem portion, electric conductorsassociated with the stem, a cone-shaped tip of insulating materialadapted to be fastened to the stem, and electrical conductors mounted onthe outside wall of the coneshaped tip and adapted to make contact withthe conductors of the 5. In a surgical instrument a stem, electricalconductors associated with the stem and extending from the end thereof,a tip of insulating material adapted to be fastened on the end of thestem and provided with channels therein which are exposed at portionsthereof in order to receive the exposed ends of the conductors and toexpose them along suitable portions of the tip.

6. In a surgical instrument of the character described, a stem,electrical conductors associated with the stem and extending therefrom,a

cone shaped tip of insulating material adapted to be fastened on the endof the stem and provided with channels adapted to receive the exposedends of the conductors. and other electrical conductors associated withthe tip and adapted to make contact with the first named conductors whenthe tip is in place on the stem.

7. In a surgical instrument adapted foruse in electrical treatment, ahandle portion, a stem porton' located within the handle portion andslidably engaged therein, conductors fastened to the handle portion andextending through and beyond the stem portion, and a removable sheath ofinsulating material adapted to fit over the exposed portions of theconductors in such manner that when the sheath is fully in place theconductors project therethrough and to be engaged on the stem wherebythe conductors may be moved in the sheath by the handle to cause andextending therefrom, a cone-shaped tip of insulating material adapted tobe located over the exposed ends of the conductors and to be removablyattached to the stem, and conductors extending along the outer wall ofthe cone-shaped tip and into the inner portion thereof to make contactwith the first named conductors when the tip is in place on the stem.

9. In a surgical instrument for electric treatment, a stem, conductorsassociated with the stem and extending therefrom, a tip of insulatingand extending therefrom and a tip of insulating material adapted to befastened on the stem over the exposed ends of the conductors and havingits own conductors which are adapted to make contact with the firstnamed conductors, the second named conductors being extended from theend of the tip and being curved and pointed in order that they may beused for the coagula tion of tonsils, tumors and bulbous bodies.

11. In a surgical instrument for electric treatment, a stem, conductorsassociated with the stem and extending therefrom and a tip of insulatingmaterial adapted to be fastened on the stem over the exposed ends of theconductors and having its own conductors which are adapted to makecontact with the first named conductors, the second named conductorsbeing extended from the end of the tip in parallel fiat relationship andat an angle with reference to the plane of the conductors within the tipin order that the instrument may be used for the treatment of outsidewalls of bulbous bodies.

12.v In a surgical instrument for electric treatment, a stem, conductorsassociated with the stem and extending therefrom, and a tip ofinsulating material adapted to be removably engaged on the stem over theexposed ends of the conductors, the tip having a pair ofparallel-extending channels therein and a portion of the side of ,thetip being cut 'away to expose the conductors when they are located inthe channels, part of the remaining material of the tip constituting aridge of insulating material between the conductors, to insure theelectrical current passing through the area to be treated and notdirectly between the electrodes.

WILLIAM J. McFADDEN.

